Rectal prolapse is protrusion of rectal tissue through the anus to the exterior of the body. The rectum is the final section of the large intestine. Symptom severity will increase with the dimensions of the prolapse, and whether or not it spontaneously reduces once defecation, requires manual reduction by the patient, or becomes irreducible. The symptoms are similar to advanced hemorrhoidal sickness. Fecal discharge causing staining of undergarments, Rectal haemorrhage, mucous rectal discharge, Rectal pain, Pruritis ani.
The only potentially curative treatment for complete rectal prolapse is surgery, however in those patients with medical problems that make them unfit for surgery, and those patients who have minima symptoms conservative measures may benefit. Dietary adjustments, including increasing dietary fiber may be beneficial to reduce constipation,and thereby reduce straining. A bulk forming agent (e.g. psyllium) or stool softener can also reduce constipation. Biofeedback retraining may be indicated to help the patient avoid straining during defecation. There is limited evidence that hypopressive exercises may be beneficial in mild pelvic organ prolapse.
Among the population studied (134 women, 11 men; median follow-up, 38.9 months [range, 21.2-67.2]), 103 patients (71%) underwent operation for their prolapse and 42 (29%) did not. According to the Cleveland Clinic Score, 139 patients (96%) suffered from fecal incontinence before treatment and 64 (46%) reported improvement at the end of the follow-up. Pretreatment history of incontinence symptoms for >2 years (hazard ratio [HR], 1.99; 95% CI, 1.14-3.46; P = .015) and ventral rectopexy (HR, 1.86; 95% CI, 1.026-3.326; P = .04) were associated with continence improvement. Patients who underwent an operative procedure other than ventral rectopexy had similar outcome as compared with nonoperated patients. Conversely, chronic pelvic pain precluded fecal incontinence improvement (HR, 0.32; 95% CI, 0.135-0.668; P = .0017).